American Red Cross Blood Services "Making A Difference" Educational Scholarship Distribution Form

Instructions: This form must be completed and submitted by an authorized representative of the participating high school. All data fields must be completed. Forms must be submitted to the American Red Cross immediately after the last blood drive of the year. (Current year runs from Labor Day to Labor Day.)

Divided Scholarship?:

Will the scholarship monies be divided among more than one student?

Scholarship Amount to this student: *

Student's Name: *

Student's SSN or Student ID: *

Student's Address: *

City: *

State: *

Zip Code: *

Student's Phone:

Student's Email:

Institution/School: *

Institution of Higher Education Attending

School Address: *

School City: *

School State: *

School Zip Code: *

School Phone : *

Date of Classes: *

Date Student Will Begin Classes

Sponsor Code: *

Blood Drive Sponsor Code

Participating School: *

Name of Student's Current School

School Phone: *

Number To Reach Student's Current School

School Official: *

Name of Authorized School Official Submitting Form

School Official's Email: *

Authorized School Official's Email Address

Your Red Cross Field Representative: *

American Red Cross Blood Services "Making A Difference" Educational Scholarship Distribution Form

Local Red Cross Blood Services